| NPI | 1639233893 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OR 12-09-60) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 101Y00000X Counselor (Licence: WA RC00054975) | |
| Enumeration Date | 2006-12-21 |
| Last Update Date | 2017-12-21 |